Loading...
HomeMy WebLinkAboutMiscellaneous - 109 SAW MILL ROAD 4/30/2018 109 SAW MILL ROAD 210/104.8-0106-0000.0 1 I I II i f M Commonwealth of Massachusetts MR City/Town of System Pumping.Record Form 4 DEP has provided this form for useeby local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using.this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility. Information 1. System Locatio . L / g front of hou , Left/Right rear of house, Left/right side of house, Left/ Right side of bui Ing, Left/ g n of building, Left/Right rear of building, Under deck Address la Q S A-J 1 p,� Cityrrown �( State Zip Code 2. System Owner. Name Address(if different from location) + 0 IS state Zip Code T .• Y Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: E] Cesspool(s) eptic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yeas L N If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of Syste 6. System Pumped By. Neil.Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Locatio here contents were disposed: ML S. Lowell Waste Water Signk464 Haule Date t5f6mu4.doc•06/03 System Pumping Record•Page 1 of 1 Commonwealth. of Massachusetts R� VE,® City/Town of I _ 7 2006 System Pumping Record JUL Form 4 OR-TH AND TOHEALTH DEP ARTM TER DEP has provided this form for use by local Boards of Health. The System Pumping Record must be submitted to the local Board of Health or other approving authority. . A. Facility Information Important: When fining out 1. !Aqe'� tem Location: forms the computeto r,useonly the tab key resst o to move your Cal � cursor-do not use the:return Cityrrown State Zip Code key. 2. System Owner: Name �I Address(if different from location) City/Town Stagei —66Zip Code' Telephone Number .B. Pumpifng Record 1. Date.of Pumping "2 �`"" g Date 2. Quantity Pumped: canons 3. Type of system: ❑ Cesspoof(s) eptic Tank ❑ Tight Tank ❑ Other(describe)' 4. Effluent Tee Filter present? ❑ Yes If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. SystePwmpAeB y Name Vehicle License Number Company 7. LocationXftre contents were di s sed: 1 Signat re o au er Date hftp://www.mass.gov/dep/­water/approvals/t5forms.htm#inspect 1 t5form4.doc•06103 System Pumping Record•Page 1 of 1 � r TOWN OF • ami:° SYSTEM PUMPING RECORD ,,.,,,,%v-:-) ,#—, U DATE: l' SEP - 7 2005 TOWN OF FORTH A^1'1OVER HEALTH D-` ARZI'.,E JT SYSTEM OWNER& ADDRESS SYSTEM LOCATION (example: left front of house) a5� ;)Ov� toy SOL U) JA;t 1 DATE OF PUMPING: ~02 QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO: G.L.S.D Lowell Waste TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: ��-oZ�-oo5 SYSTEM OWNER &ADDRESS SYSTEM LOCATION 1^ _ (example: left front of house) ko US DATE OF PUMPING: -' 6 QUANTITY PUMPED S GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES v/ NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: C� �bco�Com( COMMENTS: CONTENTS TRANSFERRED TO: k Board of*Health No..t AndoversMass annc RFACE DISPOSAL DESIGN CHECK LIST / PPROM DATE DISAPPROVED DATE, rovideds -- Reasons t � itle V FAIL - :eg 2.5 �/ The submitted plan must show as a minimum: LLL a) the lot to be served-areasdimensions lot #.gabntters b location and log deep observation hoes-distance to ties c location and results percolation tests-distance to es leaching area design calculationsddimensions of system-includinons g reserve area a location as Deed contours f) existing and prop f sewage disposal system or .7(g) location any vat areas within 100+ o ewag disclaimer-check wetlands mapping ✓(h) surface and subsurface drains within 100' of sewage disposal system or disclaimer (i) location any drainage easements within 100' of sewage disposal system or disclaimer-Planning Board files ✓(j) known sources of water supply within 200' of sewage disposal system or disclaimer ,✓(k) location of proposed well. to serve lot-100' from leaching facility (1) location of water lines on property-10' from leaching facility (m) location of benchmark driveways / (0 garbage disposals no pVC to be used in construction lamb pipe., $ tic tank (q profile of system-elevations of basements plumbs P P s s distribution box inlets and outlets, distribution field Piping and ether elevations (r) maximum ground water elevation in area sewage disposal system r (s) plan must be prepared by a Professional Engineer or other professional authorized by lax to prepare such plans Reg 6 Septic Tanks (a) capaci-�- 5o% of flows water tables tees, depth of teens access, puMPing (b) cleanout c) lA' from cellar wall or inground swi=ing Pool (d) 25+ from subsurface drains . Reg 10.2 �'' Distribution Boxes (a) $pegreater 0.08 Reg 10.11 � b) sump Subsurf&ce Design Check List Pa e 2 r FAIL OK Leaching Pits Leaching pits are preferred where the installation is possible Reg 11.2 a calculations of leaching area-md nitmum 500 eq ft 11.4 b) spacing 11.10 surface drainag a e 2� 11.11, d� cover material e 2s x'2+x4n splash pad f tee at elbow g no bends in pipe from d-box to pipe / Leaching Fields Reg 15.1 V a no greater than 20 mirnites/inch L/ b area-minimum 900 sq ft 15.4 ✓ c construction of field 15.8 v d) surface drainage 2 % 3.7 e) 201 from cellar -all or inground swin dng pool Leachin M �ches Reg 14,1 a ca'7 Dons o _leaching area-min 500 sq ft 14.3 b spacing-4 ft's n n 6 ft with reserve between 14.4 c dimensions! 1.4.6 dconstruction 11t.7 a stane ' 1410 f surface' drainage nage 2$ Dowr�ili SlOPA a s o e y x = be shown b� Y/ Z iS0 a (to be shown c s Reg 9.1 a) approval 9.6 �=ib) :Stand-by power TO: NORTH ANDOVER, MASS. December 12 1980 BOARD OF HEALTH FROM: DESIGN ENGINEER Re: Soil Absorption Sewage Disposal System This is to certify that I have inspected the construction of said disposal system at Lot 46A, Sawmill Road SITE LOCATION North Andover, Mass. The grades and construction are as specified in my plans and specifications dated December 9 19 80 OF • S O� F �S Req.,;/P- of.C.En iir/W=,_. j, o p�No. 22738,,010' �/ Commonwealth of Massachusetts v cy-A— Massachusetts System Pumping Record System Owner System Location �I Date of Pumping: S 12 - p-0-b Quantity Pumped: 5UC) gallons Cesspool: No Yes Septic Tank: No Yes System Pumped by: Ferreoort Sit&,�ftaa License# Contents transferrred to : Greater Lawrence Sanitary District Date: _ Inspector: 1 ti w � � OA to I ,r 2_ i ,R �3Eo i a N � N4` r K 0 E k r S TrN � v Lo-r 41 IE I N S r f Lo-r 45A LcT 4(oA 44)ooS s f i (3�0 •�p i �crr 4 9 I I 5 & U 1 L. T u_P�eE�rvTQ TAS- - (o 0.- -15 �KIu 2IPEL?�?IOFTA&k—__I59.91 5 �.��L.P1 I NV, PtpE OUT D.FS©X I S7 I 3 AIAooVER> FRA ,c \' F o tz � rn L, C�.�auAs STEVE LEo v4s SG4LE t " = 4b' Dares , C>EC..9 1980 • - �� FGZAt�l1C G�Et_i►.1Q,S � ASSUGIATES �t,S61t�tU--- E>2S GTS I \1 i t A� V A �m INSTALLATION,N, CH:K LZ ST LOT •, •► z,r»-L.%� (7M DATE DI SA POVED DATE ..}>CAVATIM OK FAIL FII. OK 1. Distance Tot / a. Wetlands / b. Drains c. Well 2. Water Line Location 3. No PVC Pipe:- Septic ipe:Septic Tank --.- a. Tess -_Length & To Clean Out Covers _ b. Cement Pipe to Tank - On Both Sides of Tank 5. Distribution Box a. Covers & Box - No Cracks j b. All Lines Flowing Equal Amounts C. No Back Flow b. � Leach Field or Trench / a. Dimensions b. Stone Depth- c. Capped Ends d. Clean Double Washed Stone- 7. tone-?• Leach Pits a. Dimensio b. Stone epth c. Sp ah Pads d. eas Ce ent Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted A. Lot Location s b. Dimensions of System e. Location with Regard-to Pere Test d. Elevations e: Water Table TOWN OFAv�jb� SYSTEM PUMPING RECORD DATE: A-6 rc ILII ' 9 20 � . SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example:left front of house) u. DATE OF PUMPING: QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIN) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: CONTENTS TRANSFERRED TO• f. TOWN OF SYSTEM P ING RECORD 1 DATE: � t SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example:left front of house) �A k�i ll D o � l � DATE OF PUMPING: - QUANTITY PUMPED : GALLONS CESSPOOL: NO YES SEPTIC TANK NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOODCONDITION FHL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER(EXPLAIl) SYSTEM PUMPED BY: Bateson Enterprises, Inc. COMMENTS: coNTENTs TRANSFERRED TO: G.L.S.D Lowell Waste TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: -5 SYSTEM OWNER &ADDRESS SYSTEM LOCATION (example: left front of house) �cc ,I DATE OF PUMPING: QUANTITY PUMPED L GALLONS CESSPOOL: NO � YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: COMMENTS: L. � . 142001 CONTENTS TRANSFERRED TO: Commonwealth of Massachusetts — City/Town of LITH E® System Pumping Record 007 Form 4 NDOVER TMF_NT DEP has provided this form for use by local Boards of Health. Wised;b the information must be substantially the same as that provided here. Before using this form,check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important; When filling out 1. System Lotion* forms on the computer,use only the tab key Address to move your cursor-do not City/Town St Zip Code use the return key. 2. System Owner: Name Address(if different from location) City/Town Stat( D^ - ode Telephone Number B. Pumping Record Co 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes [a--fq-o- If yes,was it cleaned? ❑ Yes ❑ No 5. Condif n of System: 6. Syst Pt, Name Vehicle License Number Company 7. Locatio l ere gontents were sed: Sign au er Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 r Commonwealth of Massachusetts City/Town of a' System Pumping Record Form 4 OCT - 9 2008 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form,-check with your local Board of Health to determine the form they use. The System Pumping Record_must,be.submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location-(Left' front, I rear, left si of hous . Right front, right rear, right side of house. forms on the computer, use only the tab key Address to move your cursor-do not City/Town State Zi Code use the return P key. 2. System Owner: .vl Name Address(if different from location) Cityrrown Statee Zip Code 'o c � Telephone Number B. Pumping Record 1. Date of Pumping pate 2. Quantity Pumped: y Gallons 3. Type of system: Cesspool(s) eptic Tank El Tight Tank Other(describe): 4. Effluent Tee Filter present? Yes _ No If yes, was it cleaned? Q Yes No 5. Conditio of Syste - ��� 6. System Pumped By: Neil Bateson F 5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. Location where contents were disposed: L.S. Lowell Waste Water Yfro-J �-o - igna ure of H"r D to e t5form4.doc•06/03 System Pumping Record•Page 1 of 1 RECEIVED -C-\ Commonwealth of Massachusetts • City/Town of OCT 16 2012 TOWN OF NORTH ANDOVERS stem Pumping Record HEALTH DEPARTMENT Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information 1. System Location a Ri t ont of , Left/Right rear of house,.Left/right side of house, Left/ Right side of bu ' g, Left/Right front of building, Left/Right rear of building, Under deck Address City/Town State U� Zip Code 2. System Owner. Name Address(if different from location) City/Town State,&6-D_66 C^Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) Septic Tank ❑ Tight Tank ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes ld'No If yes,was it cleaned? ❑ Yes ❑ No 5. Condition of Sysaft 6. System Pumped By: Neil Bateson F5821 Name Vehicle License Number Bateson Enterprises Inc Company 7. J-Signtu 4Haule ntents were disposed: Lowell Waste Water c;) Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1